By ULY CLINIC staff
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Acute Rheumatic fever in Children
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It is a non-suppurative sequela of a group A beta haemolytic streptococcal pharyngeal infection.
Diagnostic Criteria
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Primary episode of RF
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2 major or 1 major plus 2 minor plus evidence of preceding streptococcal infection
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RF recurrence in a patient without RHD
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2 major or 1 major plus 2 minor plus evidence of preceding streptococcal infection
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RF recurrence in a patient with RHD
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2 minor plus evidence of preceding streptococcal infection
Major Criteria.
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Migratory polyarthritis
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Sydenham’s chorea
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Carditis
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Erythema marginatum
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Subcutaneous nodules
Minor Criteria
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Evidence of recent streptococcal infection based on isolation of beta haemolytic Streptococcus from the throat swab, ASO titre above 200 units/ml or a reliable history of tonsillitis in the preceding month
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Fever
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Arthralgia
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Elevated acute phase reactant proteins (ESR, CRP) or prolonged PR interval
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Previous evidence of rheumatic fever based on a reliable history of a previous attack or upon the existence of previous cardiac damage.
Investigations
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FBP and ESR
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CRP
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Anti-streptolysin O titre (ASOT)
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ECG
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Chest X-ray
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Echocardiogram
Treatment
Non pharmacological treatment
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Bed rest
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Ensure adequate nutrition and fluid intake
Pharmacological treatment
A single dose of Benzathine Penicillin IM
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0.6 MU (≤20kg)
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1.2 MU (>20kg) OR
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Penicillin V PO for 10 days.
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1 month to 1yr, 62.5 mg 8 hourly,
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1-6 years, 125mg 8 hourly,
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6-12 years, 250mg 8 hourly and
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> 12 yrs 500mg 8 hourly.
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In case of Penicillin allergy
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Give Erythromycin PO 12.5mg/kg 6 hourly OR
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Cephalexin PO 25mg/kg 8 hourly for 10 days.
Pharmacological treatment of Arthritis and Carditis
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Give Aspirin PO 30mg/kg 6 hourly, reduced to one third once fever and joint pain have been abolished. There after continue until the ESR returns to normal.
If cardiac signs progress despite of adequate dose of aspirin or in case of a relapse, ADD
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Give Prednisolone PO 1mg/kg in 12 hourly for 3-4 weeks.
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Then reduce the dose gradually and discontinue when there is reduction in clinical disease.
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Aspirin is continued for at least two weeks thereafter.
Pharmacological treatment of Sydenham’s chorea
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Give Haloperidol PO 0.5mg/kg 12 hourly until symptoms subsides.
Prevention of relapses of RF
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Benzathine penicillin IM should be given every 4 weeks as routine
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Children ≤20 kg 0.6 MU
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>20kg should receive 1.2 MU IM.
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Penicillin V PO 250 mg 12 hourly may be used instead of Benzathine penicillin.
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Treat patients without proven carditis for five years after the last attack or until 18 years of age (whichever is longer).
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Treat patients with carditis for ten years after the last attack or until 26 years of age (whichever is longer).
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For patients with more severe valvular disease or who have had valve surgery, prophylaxis should be life long.
Rheumatic Heart Disease (RHD)
It is a complication of ARF which causes permanent damage to the heart valves.
Diagnostic Criteria
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Dyspnoea on exertion, cough, wheezing
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Orthopnoea
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Paroxysmal nocturnal dyspnoea
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Haemoptysis
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Exercise intolerance
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Bounding pulses, increased pre-cordial activity and impulse, displaced apical impulse, increased S2 if there is pulmonary hypertension.
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With evidence of valvular lesion on Echocardiogram.
Investigations
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ECG
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Chest-X ray
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Echocardiogram
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Cardiac catheterization
Treatment
Non pharmacological treatment
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Provide primary prophylaxis for infective endocarditis and secondary prophylaxis for acute rheumatic fever.
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Treat heart failure if present (refer to heart failure)
Note:
Patients with valvular damage should be reffered to the next level facility with adequate expertise and facilities.
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Last updated on 16.09.2020
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References
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​Tanzanian Standard treatment guideline for children 2017 edition page 101-102